Phimosis is defined as inability to retract prepuce.
Non retractile foreskins are common among young boys and is a part of normal preputial development. Prepuce of new born is non retractile and at the age of 3 years up to 10% remain non-retractile. It has been seen that 8% of boys at the age of 6 years and 1% at the age of 16 years still had non-retractile foreskin. The foreskin gradually becomes retractile secondary to intermittent erections and keratinization of the inner epithelium. That is most of the prepuce becomes retractile by adulthood.
It is important to understand that most of these phimosis are physiological and does not require any surgical intervention.
It is important to differentiate true pathologic phimosis from physiological phimosis. While physiologic phimosis consists of pliant, unscarred preputial orifice, true pathological phimosis is characterized by contracted white fibrous ring around the preputial orifice.
Most of the patients with phimosis require only reassurance and preputial hygiene. A short course of topical corticosteroids (0.15 triamcinilone / betamethasone/0.1% mometasone) twice daily for 6-8 wks has success rate of 80-90% in separating preputial adhesions and can be given if child has symptoms of straining and ballooning of prepuce.
The only indication of surgery (circumcision) is pathologic phimosis with scarred prepuce which is a result of recurrent balanitis.
Most of the phimosis are physiological and self correcting by adulthood and does not require any treatment.